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Insurance issues dealing with CMS to private insurance.

If you can’t find the information you are looking for or need help with a question, contact the FCA Insurance and Legal Liaison Office.

 

 



Aetna Agrees to Allow CMT+97140
Friday, 16 August 2013
(From an 08/14/2013 ACA Insurance Relations Dept. Update) Aetna instituted a policy effective March 1st stating that Manual Therapy (CPT code 97140) would not be recommended for separate payment when billed with Chiropractic Manipulative Treatment (CMT). It also stated that Modifiers 25 and 59 would not override to allow reimbursement. ACA first obtained agreement that claims could be appealed after being denied, with submission of proper documentation showing 97140 was performed to a separate region. After further discussion, ACA and Aetna reached a mutually beneficial solution allowing documentation to be submitted with the initial claim for review, so that there is no need for denial - a true example of successful cooperation between ACA and insurance companies. In this way, both Aetna and providers only handle the claim once. At this time, Aetna has changed its computer system to allow for documentation to be submitted on medically necessary claims that demonstrate that 97140 was performed on the same date of service as CMT, and that 97140 was performed in a region other than the region in which the CMT was performed. 

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Updates on Lawsuits Filed by the ACA against ASHN, CIGNA and UnitedHealthcare
Wednesday, 31 July 2013
(July 26, 2013) The ACA has a lawsuit pending against ASHN & CIGNA and a separate lawsuit pending against UnitedHealthCare.  Below are updates on the status of the lawsuits and an explanation of how individual chiropractors may help with data and information.  
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Aetna Appeals Result in Paid Claims
Friday, 26 July 2013
(From the ACA “Week in Review” of 07/25/13)  ACA held a meeting with Aetna representatives back in May to discuss ACA's stance on Aetna's new national policy regarding manual therapy. As a result of that meeting, Aetna agreed to allow providers to appeal and submit supporting documentation for consideration. Soon after, ACA members began reporting that submitted documentation wasn't being reviewed, and that claims were being denied. ACA contacted Aetna executives immediately in an effort to clarify whether DCs would be able to appeal denials of 97140. In response, Aetna alerted its top claims staff to assist in resolving this issue, and so far, reports are coming in that doctors are being treated politely and professionally and claims are being paid. 
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Members Ask About ASH/Cigna
Friday, 12 April 2013

Members are asking the FCA for advice about entering into a contract with American Specialty Health (ASH). In a communication dated April 9, 2013 ASH describes itself as a provider of specialty health care management, specialty Health Care Professional benefits administration. The ASH is recruiting physicians to participate in a chiropractic network to be managed on behalf of Cigna. Federal anti-trust laws prohibit the FCA from taking positions in favor of or in opposition to companies competing in the health care market. The FCA may not recommend to its members to participate or not participate with an insurance network or panel or any other business without violating anti-trust laws.

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Timely Payment of Claims
Monday, 11 February 2013

Health insurers have regulatory requirements that specify the time frame within which claims must be paid or addressed. 

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